The HIV Response Cuts Across Borders – Aidan Collins

In this blog post, Aidan writes about the importance of working across borders when it comes to developing an effective HIV response, offering some key insights drawn from the Scottish context but highlighting why we should not lose sight of the global dynamic of the HIV response, and the importance of continuing to work, learn and communicate across borders.

World AIDS Day is an opportunity for people around the world to unite and remind ourselves that HIV and AIDS have not gone away. HIV is an issue that cuts across borders – affecting individuals and communities right across the globe. However, with so much focus on devolved Scottish powers in recent years, the importance of working across borders when it comes to developing an effective HIV response can sometimes be overlooked.

Scotland’s Sexual Health and Blood Borne Virus Framework has just been updated to reflect developments over the past five years. While there has certainly been significant progress in some areas, the job is in no way complete. Scotland is meeting the UNAIDS 2020 target of 90% of all people diagnosed with HIV infection receiving sustained antiretroviral therapy. However, we do not meet the target of 90% of people living with HIV being diagnosed – this remains an area for improvement.

Increasing the numbers of people testing for HIV is key to increasing the numbers of people aware of their status. This is why the Scottish Government has updated legislation previously preventing the sale of HIV self-test kits in Scotland, with the first kits being sold here this year. In light of this change, a Scottish working group was established to produce resources and good practice guidance to support the roll-out of self-testing kits. The good practice document was the first of its kind in the world, since adapted for use in England and used internationally as an example of good practice by the World Health Organisation. This example demonstrates Scotland’s potential to contribute to the development of new world-wide strategies on HIV.

Prevention of HIV infection also remains a priority in Scotland – with no significant reduction in the transmission of HIV over the last five years. While traditional core prevention strategies (such as the provision of needles and condoms) are all very important, it is clear that new strategies need to be explored. PrEP is one such prevention approach, which was very high on the agenda of the 15th European AIDS Conference in Barcelona this year, and action at a European level has implications for progress on PrEP here in Scotland.

PrEP is an HIV prevention strategy that uses antiretroviral (ARV) drugs to protect HIV negative people from HIV infection. Results from recent scientific research show that PrEP is up to 96% effective if used as prescribed. The main drugs used in PrEP have not yet approved for prevention purposes in Europe, but many people across Europe argue that we’ve already been too patient and don’t have to wait any more to make PrEP available. In a historic move, France became the first country outside the USA, and the first country with a centrally-organised, reimbursable health system, to approve no-expense PrEP for people who need it. Will other European countries now follow suit? It’ll be fascinating to see how discussions on PrEP unfold in Scotland, the UK and across Europe in the coming year.

So far, I’ve focused on developments in health policy but also want touch on some of non-healthcare related policies relevant to HIV which essentially support health outcomes and quality of life. For example, while health services are very important, finding work, attaining education and living in a community without prejudice are just as important to people’s health and wellbeing. This is why it’s important to recognise that Scotland and the UK is part of an international community, with agreed international standards and obligations aimed at securing our civil, political, economic and social rights across all areas of our lives. In fact, human rights activists were among the first to emphasise the importance of increasing access to HIV testing as part of the right to the highest attainable standard of health. It’s important never to lose sight of the global dynamic of the HIV response, and the importance of continuing to work, learn and communicate across borders. For me, this is another reason to celebrate and reflect during World AIDS Day – the first ever global health day.
Listen to Aidan talk in a podcast on the network HERE